Abstract
Implantable cardioverter defibrillators (ICDs) can store intracardiac electrograms (EGMs) in sinus rhythm (SR), at the onset of spontaneous ventricular tachyarrhythmias (VT) or during their course. This allows the investigation of unknown features of the heart electrical activity associated with different cardiac rhythms. In this study we propose a non conventional cardiac electrical activity characterization (CEAC) that extracts quantitative information about the power spectrum wideness and variability of the beat-by-beat morphology. We analyze 293 EGMs from 40 patients who underwent implantation of St Jude Medical–Ventritex ICDs that allow the storage of EGMs with two different modes of recording: bipolar (BIP) and unipolar or far-field (FF). The EGMs are studied with this CEAC by (1) exploring differences between the CEAC measured from FF and BIP EGMs during similar cardiac rhythms, and (2) investigating the mode of recording that allows a better separation between SR and VT rhythms. Results show that, with similar cardiac rhythm, the CEACs from FF or BIP recordings are different (for SR rhythm: sensitivity 81.5%, specificity 93.6%; for VT rhythm: sensitivity and specificity 100%); thus FF and BIP EGMs analyze different aspects of cardiac activity.The CEAC applied to FF EGMs distinguishes better EGMs obtained during SR from VT rhythms (VT vs SR with sensitivity 92.7% and specificity 79.7%) than when it is applied to BIP signals (VT vs SR with sensitivity 60% and specificity 73.3%).
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References
Bloomfield DM, Steinman RC, Namerow PB, Parides M, Davidenko J, Kaufman ES, Shinn T, Curtis A, Fontaine J, Holmes D, Russo A, Tang C, Bigger JT Jr (2004) Microvolt T-wave alternans distinguishes between patients likely and patients not likely to benefit from implanted cardiac defibrillator therapy: a solution to the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II conundrum. Circulation 110:1885–1889
Boriani G, Occhetta E, Pistis G, Menozzi G, Jorfida M, Sermasi S, Pagani M, Gasparini G, Musso G, Dall’Acqua A, Biffi M, Branzi A (2002) Combined use of morphology discrimination, sudden onset and stability as discriminating algorithm in single chamber cardioverter defibrillators. Pacing Clin Electrophysiol 25:1357–1366
Buchman T (2004) Non linear dynamics, complex systems and the pathobiology of critical illness. Curr Opin Crit Care 10:378–392
Casaleggio A, Bortolan G (1999) Automatic estimation of the correlation dimension for the analysis of electrocardiograms. Biol Cybern 81:279–290
Corana A, Bortolan G, Casaleggio A (2004) Most probable dimension value and Most flat interval methods for automatic estimation of dimension from time series. Chaos Solitons Fractals 20:779–790
Eckmann JP, Ruelle D (1992) Fundamental limitations for estimating dimension and Lyapunov exponents in dynamical systems. Phys D 56:185–187
Grassberger P, Procaccia I (1983) Measuring the strangeness of strange attractors. Phys D 9:189–208
Hooke R, Jeeves TA (1969) Direct search solution of numerical and statistical problems. J ACM 7:212–229
Huikuri HV, Makikallio TH, Raatikainen MJ, Perkiomaki J, Castellanos A, Myerburg RJ (2003) Prediction of sudden cardiac death: appraisal of the studies and methods assessing the risk of sudden arrhythmic death. Circulation 108:110–115
Jekova I, Dushanova J, Popivanov D (2002) Method for ventricular fibrillation detection in the external electrocardiogram using nonlinear prediction. Physiol Meas 23:337–345
Kalahasti V, Nambi V, Martin DO, Lam CT, Yamada D, Wilkoff BL, Niebauer MJ, Jaeger FJ, Tchou PJ, Chung MK (2003) QRS duration and prediction of mortality in patients undergoing risk stratification for ventricular arrhythmias. Am J Cardiol 92:798–803
Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Saksena S, Waldo AL, Wilber D, Brown MW, Heo M (1996) Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. for the Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 335:1933–1940
Nahshoni E, Strasberg B, Adler E, Imbar S, Sulkes J, Weizman A. (2004) Complexity of the dynamic QT variability and RR variability in patients with acute anterior wall myocardial infarction: a novel technique using a non-linear method. J Electrocardiol 37:173–179
Ott E, Sauer T, Yorke JA (1994) Coping with chaos. Wiley, New York
Owis MI, Abou-Zied AH, Youssef ABM, Kadah YM (2002) Study of features based on nonlinear dynamical modeling in ECG arrhythmia detection and classification. IEEE Trans Biomed Eng 49:733–736
Perkiomaki JS, Couderc JP, Daubert JP, Zareba W (2003) Temporal complexity of repolarization and mortality in patients with implantable cardioverter defibrillators. Pacing Clin Electrophysiol 26:1931–1936
Press WH, Teukolsky SA, Vetterling WT, Flannery BP (1992) Numerical recipes. Cambridge University Press, Cambridge
Raitt MH, Klein RC, Wyse DG, Wilkoff BL, Beckman K, Epstein AE, Coromilas J, Friedman PL, Martins J, Ledingham RB, Greene HL (2003) AVID investigators comparison of arrhythmia recurrence in patients presenting with ventricular fibrillation versus ventricular tachycardia in the antiarrhythmics versus implantable defibrillators (AVID) trial. Am J Cardiol 91:812–816
Saed M, Link MS, Mahapatra S, Mouded M, Tzeng D, Jung V, Contreras R, Swygman C, Hamoud M, Estes NA, Wang PJ (2000) Analysis of intracardiac electrograms showing monomorphic ventricular tachycardia in patients with implantable cardioverter defibrillators. Am J Cardiol 85:580–587
Sanders P, Berenfeld O, Hocini M, Jais P, Vaidyanathan R, Hsu LF, Garrigue S, Takahashi Y, Rotter M, Sacher F, Scavee C, Ploutz-Snyder R, Jalife J, Haissaguerre M (2005) Spectral analysis identifies sites of high-frequency activity maintaining atrial fibrillation in humans. Circulation 112:789–797
Sauer T, Yorke JA, Casdagli M (1991) Embedology. J Stat Phys 65:579–616
Small M, Yu D, Simonotto J, Harrison RG, Grubb N, Fox KAA (2002) Uncoverng non-linear structure in human ECG recordings. Chaos Solitons Fractals 13:1755–1762
Snedecor W, Cochran WG (1989) Statistical methods. Iowa State University Press, Ames
Thomsen MB, Truin M, van Opstal JM, Beekman JD, Volders PG, Stengl M, Vos MA (2005) Sudden cardiac death in dogs with remodeled hearts is associated with larger beat-to-beat variability of repolarization. Basic Res Cardiol 100:279–287
Acknowledgements
The authors are very grateful to Josh Reiss from St Jude Medical – Sunny Vale for his comments on this paper and to Stella De Robertis for English language assistance. We also like to thank Prof. Sergio Chierchia for his helpful comments and Dr Roberto Mureddu, Dr Edoardo Casali, and Dr Natale di Belardino for their help in recruiting electrograms during the early stage of the study.
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Casaleggio, A., Rossi, P., Faini, A. et al. Analysis of implantable cardioverter defibrillator signals for non conventional cardiac electrical activity characterization. Med Bio Eng Comput 44, 45–53 (2006). https://doi.org/10.1007/s11517-005-0014-0
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DOI: https://doi.org/10.1007/s11517-005-0014-0